Pediatric emergency medicine trisk 2407 2407
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Symptom
Possible etiologies a
ED-based evaluation
Fever, acute
Otitis media, sinusitis,
pneumonia, adenitis, SSTI,
CMV
Fever,
prolonged
CMV, EBV, MAC,
tuberculosis, fungal
pathogens; recurrent otitis,
parotitis, or sinusitis;
malignancy; immune
reconstitution syndrome
PJP, bacterial pneumonia
(pneumococcus, GAS,
nontypeable H. influenzae,
Moraxella species),
tuberculosis, MAC, CMV,
fungal pathogens
(histoplasmosis,
coccidioidomycosis,
blastomycosis)
Asthma is most common,
followed by viral etiologies.
Specific HIV-associated
diagnoses: PCP, lymphoid
interstitial pneumonitis,
pneumonia, congestive
heart failure (due to
cardiomyopathy)
Cervical adenitis (GAS, S.
aureus, Bartonella ),
suppurative parotitis,
condylomata, molluscum,
folliculitis, HSV
CBC, blood culture
UA/urine culture as per febrile
infant/toddler guidelines
CXR if leukocytosis,
respiratory symptoms, or
hypoxemia
Evaluation for acute fever and
CMV antigenemia,
CMV/EBV PCR
Cough
Wheezing
Soft tissue
infections
Pulse oximetry, CXR, arterial
blood gas, LDH (elevated in
PCP), CBC, blood culture
Children may need to undergo
bronchoscopy to secure
adequate specimens for
silver stain and other
diagnostic studies
Pulse oximetry, CXR if has no
prior wheezing history,
arterial blood gas, LDH
(elevated in PCP); EKG,
BNP, cardiac enzymes if
cardiac etiology suspected
Wound cultures (bacterial and
viral) and Gram stain; blood
cultures should be obtained
in the ill-appearing child or
the febrile child; consider
